Rating individual doctors or units?

Recently it was reported that the NHS UK published individual surgeons’ performance data specifically for vascular surgery, hailed as a “historic moment” for the NHS.
It seems on the surface to be a good move in the interest of “greater transparency” but there have been some reservations e.g.

Vascular surgeon Peter McCollum told BBC Radio 4 that he opted out because the data was “inherently flawed”.
“Bad surgeons will not be picked up by this process – and it puts pressure on younger surgeons not to do any difficult surgery at all.”
He said he would prefer data to be analysed on a unit level, rather than for individual surgeons, because this would give a better picture of outcomes.

As far as procedures go, the outcome may not be solely dependent on individual doctors, rather more on teamwork as it would also depend on how good the hospital facilities are, how well trained the nurses are so on and so forth.
Even rating units can be fraught with problems as it is inherently difficult to assess complexities of procedures and how “ill” the patients are – or in other words how difficult the cases dealt with actually are. As Dr McCollum suggests, doctors and units may be swayed to deal with the “less difficult” cases as these will generally have less problems and better outcome.

Before we even hope to emulate such a practice we should ask ourselves whether our infrastructure is ready? Such an exercise requires a lot of data input and analysis which will be a nightmare unless there is universal usage of computerised medical records – something we are far far from achieving. Otherwise, it will be another terrible burden on clinical staff already inundated with huge amounts of paperwork.

I do see a major benefit with such data. It would be good to see if there are units or doctors who are performing as “outliers” and then address the specific issues and problems with the ultimate aim to improve the standard of care.